title: [Sub-urethral sling Advance(®) midterm results: patient selection and predictors of success].
abstract: OBJECTIVE
  Sub-urethral trans-obturator male slings have been propose to treat men urinary incontinence. Medium term results are lacking: only one study has been published.
  
  
  OBJECTIVE
  To evaluate the efficacy of the sub-urethral sling Advance(®) (American Medical System, Minnetonka, MN, USA) and determinate factor of success.
  
  
  METHODS
  Single center retrospective study of patients implanted with an Advance(®) for urinary incontinence after radical prostatectomy. The degree of incontinence was evaluated by number of pads used per days: mild (use of 1 to 2 pads/day), moderate (3 to 4p/day) and severe (≥5p/day). The "Cure" was defined as no pad or just one for "security reason" and "improved" as decreased more than 50% of pads use.
  
  
  RESULTS
  Between October 2007 and November 2009, 69 slings were implanted. Mean follow-up was 32.4months (±8.4months). Before treatment, 37.68% of the patients suffered from mild, 42.03% moderate and 20.29% severe urinary incontinence. At midterm, 21.8% of the patients were cured and 50.7% cured or improved. For patients who suffered from mild or moderate urinary incontinence, 23.6% were cured and 58.2% were cured or improved. The cure rate decreased with the severity of incontinence. It was respectively 30.8%, 17.2% and 14.2% for mild, moderate and severe incontinence. Failure rate was more important with severe incontinence: 78%. For patients with urethral fence pressure less than 57cmH2O, the risk of failure was multiply by 6.6. No severe complication was noted during follow-up. Only one male sling was removed.
  
  
  CONCLUSIONS
  At midterm, one patient on five was cure and half was cured or improved. The technique presented an acceptable morbidity and a good tolerance. Two predictors of success were identified: severity of incontinence and residual sphincter function. Good candidates used less than three pads per day.
authors.affiliation: Service d'urologie andrologie, CHU de Nîmes, 30029 Nîmes, France. Electronic address: nicolas.siegler@chu-nimes.fr.
authors.forename: N
authors.initials: N
authors.lastname: Siegler
authors.forename: S
authors.initials: S
authors.lastname: Droupy
authors.forename: P
authors.initials: P
authors.lastname: Costa
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects; D011474:Prosthesis Design; D012189:Retrospective Studies; D053825:Suburethral Slings; D013997:Time Factors; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*
keywords: Advance(®); Bandelette sous-urétrale Advance(®); Incontinence urinaire masculine; Male urinary incontinence; Prostatectomie; Prostatectomy; Sub-urethral sling